It's Not Over Till It's Over:The Fight for Global Polio Eradication

By Lisa Piccinini, CHHS Research Assistant

The global push for polio eradication is gaining attention again now that India, once considered the epicenter of polio, can boast over a year and a half free of new cases of the debilitating disease. India’s success is the result of a government and Global Polio Eradication Initiative (GPEI) partnership to vaccinate each newborn in the country, as well as every child coming into India from countries with active cases. Together, the Indian government and GPEI launched a massive education campaign to combat misconceptions about the vaccine, such as the myth that the vaccine causes infertility, concentrating efforts in areas identified as polio transmission hotpots. The campaign focused on reaching out to and educating influential community members about the importance and safety of polio vaccinations. Eventually, those influential people, including imams and scholars, began to endorse vaccinations and even host vaccination clinics, helping to dissolve unfounded fears about the vaccine.

Targeting poliovirus hotspots was essential because of the disease’s highly infectious nature. Poliovirus spreads particularly fast in areas with poor sanitation and can cause progressive muscle weakness or even irreversible paralysis in those infected within hours. Children under five are especially susceptible to the disease, and one in ten paralyzed persons die. Because most people infected with polio never show symptoms, the World Health Organization considers just one case of polio paralysis to be indicative of an underling epidemic–in other words, where there is one case, there are more. Vaccinations strangle the virus by depriving it of the ability to spread, resulting in success stories like India.

But, India can’t kick back and relax quite yet. Poliovirus lingers at the border between India and Pakistan, where it is still infecting children because of a lack of resources, education, and continuous re-introduction from Afghan travelers. Like Pakistan, Afghanistan has been unable to completely rid itself of the virus, particularly because violence has stalled vaccinations efforts in the south. And then there’s Nigeria, which alone carries all three polio strains and has this year suffered a four-fold surge in cases, despite a 95% reduction of new cases in 2010. India’s own success hinges on remaining vigilant against re-establishment of the disease by continuing vaccinations of Indian newborns and children entering the country. Otherwise, the country could follow in the footsteps of Angola, Chad, and the Democratic Republic of the Congo, countries that eradicated polio only to have it return via infected travelers.

The threat of poliovirus re-establishing in previously polio-free countries, like India, highlights the need for continued global childhood vaccination efforts. Otherwise, even in countries where the threat of polio seems nonexistent, like the US, a polio outbreak remains plausible through importation. When outbreaks do occur, response strategies including large-scale supplementary immunization activities and increased surveillance can prevent large set-backs in global eradication. Even when isolated, these outbreaks are particularly frustrating in countries like Nigeria, which had eradication within its grasp before vaccinations dropped off and the virus re-established itself.

Vaccination efforts are undermined by myths surrounding the vaccine, current events harming the reputation of clinics, and complacency, but India’s success suggests efforts can work again in the six countries where polio remains. As poliovirus is pushed closer than ever to global eradication, the global community must double down on its efforts to stop every last case or face a possible rude awakening if the virus returns in full-force.

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